Advances in wireless video technology and Internet communications are just what the doctor ordered for telemedicine's leap toward ubiquity. Higher image quality, shorter latency times, faster transmission speeds, and improvements in information-technology medical databases now make it practical to administer long-distance clinical healthcare, patient and professional education, and health administration.
With telemedicine, doctors can provide diagnostic and therapeutic services to patients in remote locations. A nurse or medical technician examines the patient and transmits information, e.g., vital signs, via a two-way communications link. The doctor at the other end of the link reviews the data, as well as audio and video of the patient, to determine the necessary treatment.
During last year's American Telemedicine Association convention in Denver, Colo., the Telemedicine and Advanced Technology Research Center (TATRC) demonstrated telesurgery. A surgeon at one location remotely controlled a robot that performed the actual surgery on a patient at another location. TATRC is part of the U.S. Army's Research and Materials command. Intuition Surgical Inc., the U.S. Army's Walter Reed Medical Center, Johns Hopkins University, and the University of Cincinnati also contributed to the research.
Still, most of today's telemedicine applications are relatively primitive. They typically involve the transfer of medical images and data into a database that's instantly accessible for medical services providers. The most common application is teleradiology, which is the transmission of X-rays, CT scans, and MRIs. Telepathology involves sending images of pathology slides for diagnostic consultations. In teledermatology, specialists can remotely examine digital images of a patients' skin.
Many physicians already use the Web to research diagnoses for obscure diseases. For example, doctors can access U.K.-based Isabel Healthcare's Web-based Isabel database, which has over 10,000 diagnoses.-Doctors need only enter the patient's symptom information, and the database provides appropriate potential diagnoses.
Wireless Devices Help
With wireless technology, patients can avoid visits to the doctor's office for routine and preventative healthcare tasks. These examinations are just as effective and less expensive than doctor visits. "Telemedicine light" often only needs a PDA, a notebook computer, or even a properly equipped cell phone.
Vitaphon's model 2300 looks like an ordinary cell phone. But with its four sensor buttons, patients can hold it to their chest and record an electrocardiogram (ECG) that could be sent to a doctor or medical center. Emergency personnel can even use the phone's GPS signal to locate the patient.
CardioNet came up with a two-part system that monitors patients for arrhythmia. Patients wear a three-lead sensor as a pendant or on their belt. This sensor records two channels of ECG and constantly communicates with the second device, the CardioNet monitor. Patients carry this Palm Pilot-like device in their pocket or purse. When the sensor detects an arrhythmic event, the monitor automatically transmits the ECG to the local CardioNet Center. Personnel there respond to the report and execute the appropriate medical attention.
Korean company Healthpia embeds glucose-monitoring electronics into cell phones for diabetics. The user inserts a diabetes test strip into the phone, which then sends blood-sugar information to a medical practitioner. Along the same lines, Switzerland-based Card Guard has a line of wireless devices that transmit the patient's blood pressure, blood oxygen levels, and weight to a health-monitoring center.
Even Microsoft is getting into the act. Its researchers have developed software that interconnects inexpensive physiological monitors to smart phones via Bluetooth transmissions.
Home Health Monitoring
Wireless home-based medical health-monitoring systems are a growing segment within the telemedicine arena. Products include the VitTelCare from ViTel Net, a highly customizable health monitoring and patient education system.
ViTel Net's technologies are based on the firm's service-oriented architecture (SOA), which uses a MedVizer informatics integration platform tool with a layered architecture (Fig. 1). In such an environment, nodes on a network make resources available to other network participants as independent services that can be accessed in a standardized manner.
Patients can activate the wireless WristClinic monitoring system from Ireland's Telcomed Advanced Industries Ltd. at preset times to transmit several medical parameters to a telemedicine call center or an automated Web data bank. Also, Honeywell's HomeMed Health Monitoring system cost-effectively monitors chronically ill and other patients from their homes (Fig. 2). It consists of a telemonitoring home unit and a central station that receives the data and presents it to a medical provider for analysis.
Philips' interactive TeleStation platform enables efficient two-way communication between at-home patients with congestive heart failure and healthcare providers (Fig. 3). Patients can even let doctors monitor their health through their TV sets with the company's Motiva system.
Cost Effectiveness, Education
Despite these impressive examples, widespread use of telemedicine is seeing only incremental gains. It's finding many applications in niche markets, where its high costs aren't a primary consideration. Many experts say that telemedicine must be self-supporting and rely less on subsidies before it can grow.
Other infrastructure and legal hurdles must be overcome, too, in addition to the cost element. Some medical practitioners view telemedicine as a threat. They prefer to see and touch the patient in person, trusting their own senses over remote equipment. Privacy issues need to be resolved as well, since patient data becomes available to a wider range of individuals and organizations.
Still, subsidies are helpful and are needed for telemedicine's growth. Last year, the U.S. Senate Committee on Governmental Affairs introduced the Improve Interoperable Communications for First Responders Act. It authorizes a budget of $3.3 billion over five years for continued telehealth initiatives and an additional $126 million for research.
The market for telemedicine to monitor patients with chronic illnesses should get a boost from a Centers for Medicare and Medicaid Services demonstration project. Known as ACCENT (Advancing Chronic Care through E*Health Networks and Technologies), it will enable medical groups in Wenatchee, Wash., Bend, Ore., and Las Vegas to provide care management services to up to 2000 Medicare beneficiaries.
Founded in 1994 by Brigham and Women's Hospital and Massachusetts General Hospital (MGH), the non-profit Partners HealthCare integrated health-care system offers a continuum of coordinated high-quality care. It includes primary care and specialty physicians, community hospitals, the two founding academic medical centers, specialty facilities, community health centers, and other health-related entities. One of its programs is TeleStroke, which neurologists can use to treat stroke patients without seeing them in person.
Brain Saving Technologies (BST) also has developed a telemedicine stroke system. This videoconferencing system is being installed at the University of Massachusetts Medical Center and three of its affiliates (Fig. 4).
Despite telemedicine's potential life-saving benefits, it has yet to make the leap to mainstream routine healthcare. Bill Crounse, the global healthcare manager for Microsoft Corp., is more bullish on telemedicine's future, though. He feels that retirees, a group that's growing rapidly due to longer lifespans, are feeling especially vulnerable as more and more companies cut back or eliminate their healthcare benefits. To him, telemedicine is a good solution.
"The worst might be yet to come. The real money issue in our healthcare system is not that it costs too much to perform complicated surgical procedures, although they're hardly inexpensive," he says. "No, the elephant in the room is the cost of chronic care: treating millions of people with illnesses like diabetes, cancer, congestive heart failure, asthma, and other debilitating diseases."
Crounse believes wireless technology will be the basis for future telemedical services.